Professionals' views on patient involvement in acute psychiatric wards: A qualitative study

PURPOSE

To examine multiprofessionals' views on patient involvement in acute psychiatric wards.

DESIGN AND METHODS

The study was conducted in four hospital districts in Finland. The data were collected between December 2016 and March 2017 by means of four focus group interviews and analyzed with inductive content analysis.

FINDINGS

The five main themes emerged: Patient-, carer-, professional-, hospital-, and healthcare system-related factors enhancing or preventing patient involvement in acute psychiatric wards.

PRACTICE IMPLICATIONS

The findings confirm that many obstacles need to be removed in ward practice before patient involvement can really be made a part of the daily routine.

Service user involvement in a secure setting before and after the implementation of recovery-oriented practice: A quasi-experimental study

AIM

To measure change in service user involvement in secure mental health units, before and after the implementation of recovery-oriented practice.

DESIGN

Quasi-experimental study pretest-posttest design with non-equivalent comparison groups.

METHODS

Data were collected from May 2018 to December 2019 in four medium-/high-security units in Norway. Two intervention units that implemented recovery-oriented practice were compared with two comparison units that did not. Data were obtained using anonymous questionnaires at baseline and at 6-month follow-up. For intervention units, data were also obtained at a 12-month follow-up to measure sustainability of improvements over time. Twenty inpatients ('patients'; intervention group: 10, comparison group: 10) and 141 members of frontline staff ('service providers'; intervention group: 92, comparison group: 49) participated at baseline. Mann-Whitney U-tests and independent sample t-tests were applied at the group-level to analyse changes in mean scores in groups.

RESULTS

Among patients in the intervention units, findings indicated no improvements after 6 months, but significant improvements after 12 months in terms of patients' opportunities to participate in formulating their individual care plans, to influence decision-making about therapy and to receive information about complaint procedures. Opportunities to participate in discussions about medication and treatment regimens did not improve. After 6 months, service providers in the intervention units reported an increase in democratic patient involvement, patient collaboration and management support, but not in carer involvement and assisted patient involvement. The improvements in democratic patient involvement and management support were sustained over time. No changes were found in the comparison groups.

CONCLUSION

The patients and the service providers reported a higher degree of service user involvement after implementing recovery-oriented practice. Specific work is needed to ensure patients' involvement in all domains.

IMPACT

The findings are encouraging with respect to the potential to increase empowerment in a restricted setting through the implementation of recovery-oriented practice.

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare

BACKGROUND

The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets. Whilst a multitude of change management methodologies exist, their application in complex healthcare contexts remains unclear. Our review sought to establish the methodologies applied, and the nature and effectiveness of their application in the context of healthcare.

METHODS

A systematic review and narrative synthesis was undertaken. Two reviewers independently screened the titles and abstracts followed by the full-text articles that were potentially relevant against the inclusion criteria. An appraisal of methodological and reporting quality of the included studies was also conducted by two further reviewers.

RESULTS

Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. The most commonly applied methodologies were Kotter's Model (19 studies) and Lewin's Model (11 studies). Change management methodologies were applied in projects at local ward or unit level (14), institutional level (12) and system or multi-system (6) levels. The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches.

CONCLUSION

Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified. Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies.